Impact of an Aging Society

Primary Prevention: Preventative Measures Leading to Better Health Outcomes(August 25th, 2006)

Impact of an Aging Society

In the early 20th century, only 3 million people (4%) in the U.S. were over the age of 65.

Life expectancy has continued to increase. Today, more than 36 million Americans are over the age of 65. Over the next 25, years, over 70 million Americans will be over 65. They will be racially and ethnically diverse.

According to statistics, a child born in 2003 can expect to live 77.6 yearsCan increase from 75.4 years in 1990.

The aging population is increasing the demand for health care and social services.

Health status of the population

It appears that more older individuals are living independently and enjoying it more than in the past.

Currently, about 80% of older adults have at least one chronic condition, and 50% have at least two.

Chronic illnesses can cause many years of disability, pain, and lost function. Three million older adults have trouble performing basic activities of daily living such as bathing, dressing, and eating.

Because the elderly population will be older and larger in the coming years, overall U.S. health care costs are projected to increase substantially by 2030.

According to the latest reports from the National Center for Health Statistics, half of all Americans aged 55 to 64 have high blood pressure; 40 percent are obese.

Despite the benefits of regular activity, only 31% of adults in the United States report engaging in recommended amounts of physical activity (i.e., 30 minutes of moderateintensity activity 5 or more days per week or 20 minutes of vigorous activity 3 or more days per week), and 38% report no leisuretime regular physical activity.

Causes of Death Among U.S. Adults Aged 65 or Older

In 2001, the leading causes of death among U.S. adults aged 65 or older were:

• Heart Disease 33%
• Cancer 22%
• Stroke 8%
• Chronic Lower Respiratory Diseases 6%
• Influenza & Pneumonia 3%
• Diabetes 3%
• Alzheimer's Disease 3%
• All other causes 23%.

Opportunities To Improve Older Americans= Health and Quality of Life

Deaths from heart disease, cancer and strokeCthe nation=s three leading killersChave been dropping steadily.

Aging and Chronic Disease

Aging is a continuous process of change that begins at conception. Everyone experiences physical changes as they age. Eventually, he time comes when diseases associated with aging begin to appear.

Among the most important changes accompanying aging is the reduced reserve capacity of vital organs. This means that organs such as the heart, lungs, and kidneys that are affected by age and disease may not be able to respond adequately to additional illness or strain. Failure of organs may fail or may initiate a Achain reaction@ or Adomino effect@ of failure in body organ systems.

There is considerable growth in the field of anti-aging medicine. However, at present, there are not any effective anti-aging medicines.

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Nevertheless, no one wants to become severely incapacitated or dependent on others. It is possible to prevent or slow the onset of certain diseases associated with aging or those that cause serious illness and disability with age.

By definition, chronic diseases are incurable. But disease does not have to lead to dysfunction and disability. Even after the effects of aging and illness occur, it is still possible to try to minimize complications and reduce risks.

A major goal of care for older adults is preventing, delaying or successfully treating the diseases that shorten life and/or impair its quality.

Prevention

Preventing health problems is one of the few known ways to stem rising health care costs. By preventing disease and injury, we also can help seniors remain independent for as long as possible, which can improve their quality of life and delay the need for costly longterm care.

Preventive Efforts

Prevention is generally classified as primary, secondary, and tertiary

Primary prevention refers to preventing a condition from occurring; for example, preventing high blood pressure or diabetes.

Secondary and tertiary prevention refer to preventing complications or worsening of existing complications; for example, preventing a stroke in someone with hypertension or preventing falling with fracture in someone who has had a stroke.

Goals of Prevention

Primary prevention appears to be more effective when it is started in youth and young adulthood.

Primary prevention is less effective when begun in old age. There, the emphasis shifts to secondary and Bmost of allB tertiary prevention.

Prevention in older individuals should focus not only on reducing premature morbidity and mortality but also on preserving function and quality of life, minimizing pain and discomfort, enhancing autonomy, and minimizing subsequent need for more costly and prolonged medical care.

Primary prevention

Poor health and loss of independence are not inevitable consequences of aging. Certain strategies have proven effective in improving the health of older adults, including:

- Early detection of diseases, including screening to detect chronic diseases early in their course, when they are most treatable.

- Healthy lifestyles, including diet, physical activity, and not smoking. Habits acquired when younger, such as addiction to tobacco, can increase the risk of chronic disease in later life.
Maintaining a healthy lifestyle is challenging, and may have less impact once chronic diseases have become established. But continuing a healthy lifestyle throughout life can often prevent more severe chronic conditions in those who have not yet suffered from them.

- Preventing injury, including those due to falls.

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- Immunizations. Over 35,000 people aged 65 or older die each year of influenza and other forms of pneumonia.
Immunizations can reduce the risk of getting these infections or may reduce the severity of infections that arise.

Smoking

Tobacco use is the leading preventable cause of illness and death in the United States, increasing the odds of developing many kinds of cancer and the risks of cardiovascular and respiratory diseases. It results in approximately 440,000 deaths each year.

According to the CDC, an estimated 44.5 million adults in the United States smoke cigarettes even though smoking will result in death or disability for half of all continuing smokers. More than 8.6 million people in the United States have at least one serious illness caused by smoking.

Smoking could cause an estimated 5 million people currently younger than age 18 to die prematurely of a tobaccorelated disease. Directly or indirectly, tobacco use leads to more than $75 billion per year in medical expenditures and another $92 billion per year in lost productivity.

Physical Activity

Physical activity is an important determinant of body weight. Physical activity influences physical fitness (which is related to the ability to perform physical activity). Physical activity helps prevent and can help reverse overweight and obesity. Activity and fitness can help reduce mortality and morbidity related to overweight and obesity and can reduce mortality in those with diabetes.

According to one study, exercise counseling with a prescription for walking at either a hard intensity or high frequency produced significant long-term improvements in cardiorespiratory fitness. More exercise or the combination of hard intensity and high frequency exercise may provide additional benefits, including larger fitness changes and improved lipid profiles.

Avoiding a sedentary lifestyle during adulthood not only prevents cardiovascular disease independently of other risk factors but also substantially expands the total life expectancy and the cardiovascular diseaseBfree life expectancy for men and women. This effect is already seen at moderate levels of physical activity, and the gains in cardiovascular diseaseBfree life expectancy are twice as large at higher activity levels.

Vigorous walking has been shown to provide substantial aerobic activity. Significant benefit from walking can be obtained from approximate 45 minutes a day, an average of five days a week.

Strength training is another important component of physical activity. It helps to build and maintain bone and muscle mass, which otherwise diminish with age.

Flexibility and balance training can help reduce chronic muscle tension and stiffness that cause pain and disability and may increase fall risk with age.

Woman can reduce the risk of osteoporosis by consuming calcium and exercising regularly when they are younger and throughout their premenopausal years.

Stress reduction

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Stress cannot be eliminated, but it is possible to reduce its harmful effects on the body. Effective techniques can include resolving personal and family issues, staying active, and using relaxation techniques.

Diet and nutrition

The negative consequences of inactivity (an estimated 24 billion dollars) and obesity (an estimated 70 billion dollars) contributed significantly to total health care costs in 1995. Indirect costs include physician visits, disability, premature mortality, and impaired quality of life. Increasing weight increases the risks of diabetes, cardiovascular disease and hypertension and their complications.

There are many ideas about the impact of diet and nutrition, and many proposals for the right kind of nutrition. In general, diet advice can be summarized as: eating a varied diet, with as much fresh food as possible, including lots of fruits and vegetables, and that includes carbohydrates, fat and protein in every meal. Minimize consumption of processed and fast food. Women and smaller, less active people should consume fewer calories, while men and larger, more active people need more calories. Calories should be derived approximately 40% to 50% from carbohydrates, 30% from fat and 20% to 30% from protein.

It is apparently helpful to eat more whole grains (not products made from wholewheat flour), beans, winter squashes and sweet potatoes, and to minimize eating foods with wheat flour and sugar, including bread and most packaged snack foods.

Fat should be in a ratio of 1:2:1 of saturated to monounsaturated to polyunsaturated fat. Oils for cooking should include extravirgin olive oil, canola oil, or certain varieties of sunflower and safflower oil. It is advisable to avoid margarine, vegetable shortening and any products made with partially hydrogenated oils. Saturated fat should be reduced by eating less butter, cream, cheese and other fullfat dairy products, chicken with skin intact, fatty meats and products made with coconut and palmkernel oils. Foods with omega3 fatty acids are recommended, including salmon, sardines, herring, and walnuts; or alternatively a fishoil supplement can be taken.

It is advised to eat more vegetable protein, especially from beans. Consumption of animal protein is best limited to fish and reducedfat dairy products.

Fruits, vegetables and mushrooms are recommended, including berries, tomatoes, orange and yellow fruits, and dark leafy greens.

Other foods that appear to be beneficial include moderate amounts of red wine and plain dark chocolate.

Although controversial, some recommend diet or supplements that provide daily amounts of Vitamin C, vitamin E, selenium, carotenoids, folic acid, calcium, vitamin D, and fish oil.

Oral and dental health

Oral health is critical for good nutrition and because gum disease is an important cause and precursor of heart trouble and possibly aspiration pneumonia.

Screening and prevention

Emphasis should be on offering interventions that are proven to be most effective to those who are at highest risk of significant clinical problems in older individuals, such as cardiovascular diseases, malignancies, thyroid disease, diabetes, and certain infections.

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When to screen

Different targets and frequencies for screening are recommended for different age groups.

Age 85 is often suggested as a general cutoff range for doing conventional screening tests.

But in healthier individuals above that age with a good prognosis, it should be individualized.

Screening and prevention

Best proof is available for the following:

- Breast cancer screening

- Smoking cessation

- Hypertension treatment

- Vaccination for infectious diseases

Other measures likely to be beneficial include physical exercise.

Alzheimer=s disease

Studies have identified genes that may be responsible for being predisposed to Alzheimer=s.

Alzheimer=s is believed to be a disease where critical brain cells are destroyed by deposition of a protein called amyloid. This may be caused or associated with chronic inflammatory processes in the body.

Medications to date may improve symptoms of Alzheimer=s, especially in its early stages, and may slow the progress of the disease.

Antiinflammatory agents, such as aspirin and the nonsteroidal antiinflammatory drugs; statin medications (used to lower blood LDL and cholesterol); are often recommended.

Antibodies that clear the amyloid plaques in the brain, thought to be responsible for Alzheimer=s, are being tested and may soon be available.

Arthritis

Arthritis actually includes over 100 different diseases and conditions, including osteoarthritis, gout, rheumatoid arthritis, and fibromyalgia.

Nearly twothirds of people with arthritis are younger than 65. Common symptoms include pain, aching, stiffness, and swelling in or around the joints. Some forms of arthritis, such as rheumatoid arthritis and lupus, can affect multiple organs and cause widespread symptoms.

According to the CDC, arthritis is a major public health problem, and the leading cause of disability, and has been estimated to result in:

- 9,500 deaths

- 750,000 hospitalizations

- 16 million people with limitations

- 36 million ambulatory care visits

- 43 million people with selfreported, doctordiagnosed arthritis

- 51 billion in medical costs and $86 billion in total costs

In 2002, 43 million American adults (about 1 in 5) reported diagnosed arthritis. These numbers are expected to increase as the population ages.

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There are ways to prevent arthritis and to reduce the symptoms, lessen the disability, and improve the quality of life for people with arthritis.

Weight control and injury prevention measures can lower the risk for getting osteoarthritis. Weight control and prudent physical activity can reduce related pain and disability.

Some newer drugs can reduce the damage and control the symptoms of rheumatoid arthritis, although these may also have serious complications.

Exercise can reduce the disability of osteoarthritis, especially of the knees, in people over 50.

Cancer

Cancer is another major cause of illness and death.

More malignancies can now be detected and successfully treated than ever before.

Risk factors for various cancers are generally known, and much is known about reducing cancer risk. Consumption of fruits and vegetables, and physical activity (for breast cancer) are protective. Tobacco use, overweight and obesity are important avoidable causes of cancer.

Treatments for many cancers have improved.

Screening tests for breast, cervical, and colorectal cancers reduce the number of related deaths by early detection. Screening tests for cervical and colorectal cancers may help prevent some of these cancers from developing by detecting treatable precancerous conditions.

Cancer risk can be reduced by a healthier lifestyleCfor example, avoiding tobacco use, increasing physical activity, achieving optimal weight, improving nutrition, and avoiding excessive sun exposure.

Diabetes

According to the CDC, the number of people in the United States with diagnosed diabetes has more than doubled, reaching 14.6 million in 2005. One in five adults over age 65 has diabetes. Although more than 20.8 million Americans have diabetes, 6.2 million do not know they have the disease.

An estimated 41 million U.S. adults aged 40B74 years have prediabetesCthat is, their blood sugar level is elevated but is not high enough to be classified as diabetes. People with prediabetes are at high risk for developing diabetes. Progression to full-blown diabetes can be prevented by weight reduction, a lowfat diet, moderate exercise and medications.

People with diabetes have a shortage of insulin or a decreased ability to use insulin. Insulin is needed to allow sugar to enter cells and be converted to energy. Uncontrolled diabetes can damage vital organs, over time. Diabetes can cause heart disease, stroke, blindness, kidney failure, and lowerextremity amputations. Heart disease is the leading cause of diabetes related deaths, and death rates are about 2B4 times higher for adults with diabetes than for those without the disease.

Studies have found that better blood sugar control reduces the risk for eye disease, kidney disease, and nerve disease by 40% in people with type 1 or type 2 diabetes. A healthy diet and modest physical activity can reduce the risk for type 2 diabetes.

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Blood pressure control reduces the risk for heart, eye, kidney, and nerve diseases and stroke among people with diabetes. Improved blood cholesterol can reduce cardiovascular complications. Detecting and treating diabetic eye disease with laser therapy can reduce the risk for loss of eyesight. Comprehensive foot care can reduce amputation rates.

Heart disease

According to the CDC, heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for nearly 40% of all annual deaths.